Sterling C. Hilton

A clinical trial to improve high blood pressure care in young urban black men: recruitment, follow-up, and outcomes.

This randomized trial recruited and followed underserved, inner-city, hypertensive (HTN), young black men and investigated whether a nurse-community health worker team in combination with usual medical care (SI) increased entry into care and reduced high blood pressure (HBP), in comparison to usual medical care (UC) alone. Emergency department records, advertising, and BP screenings identified potential participants with HBP. Telephone calls and personal contacts tracked enrollees. Of 1391 potential participants, 803 (58%) responded to an invitation to be screened and scheduled a visit. Of these, 528 (66%) kept an appointment, 207 (35%) were BP eligible, and 204 (99%) consented to enroll. At 12 months 91% of men were accounted for and 85.8% (adjusted for death, in jail, or moved away) were seen. Mean BP changed from 153(16)/98(10) to 152(19)/94(11) mm Hg in the SI group and 151(18)/98(11) to 147(21)/92(14) mm Hg in the UC group (P = NS). High rates of participation are attainable in this population; however, culturally acceptable ways of delivering HBP care are needed.

Restless legs syndrome and near-infrared light: An alternative treatment option

There are few treatment options in managing restless legs syndrome (RLS); the most frequently used are dopaminergic drugs and movement. New treatment options are highly sought after. This study evaluated the effectiveness of monochromatic near-infrared light treatment in decreasing symptoms associated with RLS. The design used was 2×6 repeated-measures design with two groups (treatment and control) and six repeated measures (baseline, weeks 1–4, and posttreatment). Data collection took place in the university modalities laboratory. Thirty-four volunteers with symptoms of RLS were randomly assigned to a treatment or control group. Over a 4-week period subjects underwent twelve 30-min treatments to their lower legs with near-infrared light. The International RLS rating scale (IRLS) was used to assess and track patient symptoms. There was a steady decrease in symptoms associated with RLS over the 4 weeks in the treatment group. After 4 weeks of treatment the treatment group had a significantly greater improvement in restless legs syndrome symptoms than the control group (p<0.001); improvement was still significant after 4 weeks posttreatment compared to baseline (p<0.001). Treatment with near-infrared light does decrease symptoms associated with RLS as demonstrated in lower IRLS scores. This new noninvasive method of treating RLS might become a valuable new management option. More research is needed to determine the mechanism(s) behind infrared light treatment and RLS.

Improvement in clinical markers in CF patients using a reduced glutathione regimen: An uncontrolled, observational study

CFTR mutation, which causes cystic fibrosis (CF), has also recently been identified as causing glutathione system dysfunction and systemic deficiency of reduced glutathione (GSH). Such dysfunction and deficiency regarding GSH may contribute to the pathophysiology of CF. We followed 13 patients (age range 1-27 years) with cystic fibrosis who were using a regimen of reduced glutathione (GSH), including oral glutathione and inhaled buffered glutathione in an uncontrolled, observational study. Dosage ranged from 66-148 mg/kg/day in divided doses, and the term examined was the initial 5.5 months of GSH use (45 days of incrementally adjusted dose, plus 4 months of use at full dosage). Baseline and post-measurements of FEV1 percent predicted, BMI percentile, and weight percentile were noted, in addition to bacterial status and pulmonary exacerbations. Significant improvement in the following clinical parameters was observed: average improvement in FEV1 percent predicted (N=10) was 5.8 percentage points (p<0.0001), average weight percentile (N=13) increased 8.6 points (p<0.001), BMI percentile (N=11) improved on average 1.22 points (p<0.001). All patients improved in FEV1 and BMI, if measured in their case; 12 of 13 patients improved in weight percentile. Positive sputum cultures of bacteria in 11 patients declined from 13 to 5 (p<0.03) with sputum cultures of Pseudomonas aeruginosa becoming negative in 4 of 5 patients previously culturing PA, including two of three patients chronically infected with PA as determined by antibody status. Use of a daily GSH regimen appears to be associated in CF patients with significant improvement in lung function and weight, and a significant decline in bacteria cultured in this uncontrolled study. These findings bear further clinical investigation in larger, randomized, controlled studies.

The Role of Administrator Characteristics on Perceptions of Innovativeness among Public School Administrators

Pressures for reform require greater innovativeness among public school administrators than in the past. Perceptions of innovativeness, which function as administrators’ reality and influence participation in innovation, are reflected in their informal network relationships. Using network methods and descriptive statistics, this article explores a public school administrator network, highlighting the relationship of administrator characteristics (personal demographics, position, experience) on three different types of perceptions of innovativeness: (a) being perceived by others as innovative, (b) perceiving others as innovative, and (c) mutually perceiving each other as innovative. Findings indicate demographics of age and experience were related to administrators being perceived as innovative, suggesting the value of increased visibility and administrative stability. No association was found between administrator characteristics and either perceiving others or having mutual perceptions of innovation suggesting a potential lack of bias in who perceives others as innovative or in establishing mutual perceptions of innovation.

Sociocultural Aspects of Russian‐Speaking Parents’ Choice of Language of Instruction for Their Children in Estonia

In most cases, parents whose native language is not predominant in the area they live in have no opportunity to choose the language for their children’s instruction in schools. However, in some areas language minority families have options regarding the language of instruction (e.g., Finns in Sweden and Russians in Estonia). This article focuses on language choice from the viewpoint of these families. Typically, discussions of language of instruction have focused on integrative issues, such as creating loyal citizens, or instrumental or practical issues, such as education or labor market opportunities (Mets 2004). Choice, however, may have deeper cultural and emotional meanings for families, and such meanings may need to be considered by policy makers. In the United States, for example, policy debates on language of instruction have largely focused on whether or not to employ bilingual education strategies. In fact, states such as California, Arizona, and Massachusetts have forbidden (via referenda) the use of bilingual education, mandating English immersion, with approximately a year of transition in limited instances. Consequently, research in this area has become so politicized that, when a panel of scholars from the National Research Council studied the issue and found a positive effect from bilingual education, an opponent of bilingual education wrote that the report of the panel was intended to convey that “there is no evidence that there will be long-term advantages or disadvantages to teaching limited-English students in the native language” (Glenn 1997, 66). The study directors themselves had stated to the contrary: “Empirical results . . . support the theory underlying native language instruction” (August and Hakuta 1997, 147). Similarly, a recent meta-analytical study regarding the effectiveness of bilingual versus monolingual educational methods conducted by a panel of researchers appointed by the Bush administration found small to modest gains from bilingual programs. However, the Bush administration, after seeing the findings, declined to release the report (Krashen and McField 2005). In such a highly charged policy climate in the United States, most parents do not have a choice in the language of instruction for their children’s schooling. The U.S. language policy clearly is limiting families’ language

Toward a better understanding of the comparatively high prostate cancer incidence rates in Utah

BackgroundThis study assesses whether comparatively high prostate cancer incidence rates among white men in Utah represent higher rates among members of the Church of Jesus Christ of Latter-day Saints (LDS or Mormons), who comprise about 70% of the states male population, and considers the potential influence screening has on these rates.MethodsAnalyses are based on 14,693 histologically confirmed invasive prostate cancer cases among men aged 50 years and older identified through the Utah Cancer Registry between 1985 and 1999. Cancer records were linked to LDS Church membership records to determine LDS status. Poisson regression was used to derive rate ratios of LDS to nonLDS prostate cancer incidence, adjusted for age, disease stage, calendar time, and incidental detection.ResultsLDS men had a 31% (95% confidence interval, 26% – 36%) higher incidence rate of prostate cancer than nonLDS men during the study period. Rates were consistently higher among LDS men over time (118% in 1985–88, 20% in 1989–92, 15% in 1993–1996, and 13% in 1997–99); age (13% in ages 50–59, 48% in ages 60–69, 28% in ages 70–79, and 16% in ages 80 and older); and stage (36% in local/regional and 17% in unstaged). An age- and stage-shift was observed for both LDS and nonLDS men, although more pronounced among LDS men.ConclusionsComparatively high prostate cancer incidence rates among LDS men in Utah are explained, at least in part, by more aggressive screening among these men.

Oral Reduced L-Glutathione Improves Growth in Pediatric Cystic Fibrosis Patients

Background and Objective: Consensus nutritional guidelines for patients with cystic fibrosis (CF) recommend aggressive treatment of growth failure. Oral reduced glutathione (GSH) has been shown to improve cachexia and case reports have demonstrated improved growth in pediatric patients with CF. No controlled studies using oral GSH in CF have, however, been reported. The aim of the study was to determine whether oral GSH could improve growth in CF. Secondarily, to determine whether oral GSH could improve other systemic clinical markers. Methods: We performed a placebo-controlled, randomized, double-blind, repeated-measures clinical trial in 44 pediatric patients with CF ages 18 months to 10 years. Primary outcomes were change in weight percentile, body mass index (BMI) percentile, height percentile, and fecal calprotectin. Secondary outcomes included liver function tests and measures of systemic inflammation. Each participant was studied for 6 months, with data obtained at baseline, 3 months, and 6 months. Blood samples were obtained on the baseline and 6-month visits. Subjects were treated with oral GSH or placebo (calcium citrate), each 65 mg · kg−1 · day−1 divided into 3 doses per day at mealtimes, and administered daily for 6 months. Results: The GSH treatment group gained an average of 0.67 standard deviation (SD) in weight-for-age-and sex z score (wfaszs), (19.1 weight percentile points) during the course of 6 months, with no adverse effects (vs placebo with an increase of 0.1 SD in wfaszs [2.1 weight percentile points], P < 0.0001). Fecal calprotectin improved, GSH −52.0 vs placebo 0.5), also BMI for GSH improved 0.69 SD BMI-adjusted-for-age-and-sex z score versus placebo 0.22 SD (BMI percentile 21.7 GSH vs 5.2 placebo), and height 0.2 SD in height-for-age-and-sex z score (hfaszs) GSH versus −0.06 SD hfaszs placebo [height percentile 7.0 GSH vs −2.6 placebo], all P < 0.0001). Secondary outcomes improved significantly, as well. Conclusions: Oral reduced L-GSH significantly improves measures of growth status and gut inflammation in CF.

Ethnic Identification and School Language of Russian-speaking Students in Estonia

Ethnic identification is closely tied to language. Society’s appreciation of one’s first language and the opportunity to use it may help strengthen ethnic identification. This research examined the relationship between ethnic identifications and school language and investigated other factors that potentially impact language-minority students’ ethnic identification. The paper consists of empirical data analysis and follow-up research among Russian-speaking children attending Estonian-language and Russian-language schools in Estonia. The research was based on survey data of 186 students and their parents, utilizing a multiple logistic regression model. School language was overwhelmingly shown to be the most important factor explaining children’s ethnic identification. The odds of Russian-speaking children having an Estonian identification were extremely high, over a hundredfold, for children attending Estonian-language schools compared to children attending Russian-language schools. The follow-up study of 8,340 Russian-speaking students and an interview of 224 Russian-speaking students in Estonia confirm the strong relationship of ethnic identification and school language. These are significant findings whose implications need to be considered in policy making and school practices.

Decreased Symptoms without Augmented Skin Blood Flow in Subjects with RLS/WED after Vibration Treatment

STUDY OBJECTIVES Vascular disturbances leading to tissue hypoxia have been named as a possible cause for RLS/WED. Vibration to the whole body (WBV) in subjects with RLS/WED results in increased skin blood flow (SBF). The aims of this investigation were to (1) determine if a two-week treatment with WBV will decrease symptoms associated with RLS/WED and, (2) if so, determine if the mechanism for improvement in symptoms is related to an increase in SBF, as measured in flux. METHODS Eleven subjects with RLS/WED underwent 2 weeks of 14-minute intermittent WBV and a 2-week sham treatment in randomized order. Pre and post intervention RLS symptom severity were compared. Baseline SBF was compared between subjects with RLS/WED and an age- and sex-matched control group. A crossover design (aim 1) and a matched case-control design and repeated measures design (aim 2) were used. The data analyses consisted of 2-sample and paired t-tests; where applicable we used a standard crossover design adjustment. RESULTS WBV did significantly decrease symptoms associated with RLS/WED compared to baseline data and compared to sham treatment. The baseline flux was significantly lower in RLS/WED subjects than matched controls, but this deficit was negated with WBV. There was no increase in resting SBF over the 2 weeks of treatment. CONCLUSIONS Subjects with RLS/WED have decreased SBF but are able to increase flux to the same level as normal subjects with WBV. A 2-week intervention with WBV decreases symptoms associated with RLS/WED, but this does not seem to be related to an increase in resting SBF.

Performance on the Functional Movement Screen in older active adults

Background The Functional Movement Screen (FMS™) has become increasingly popular for identifying functional limitations in basic functional movements. This exploratory and descriptive study was undertaken to confirm feasibility of performing the FMS™ in older active adults, assess prevalence of asymmetries and to evaluate the relationship between functional movement ability, age, physical activity levels and body mass index (BMI). Methods This is an observational study; 97 men (n = 53) and women (n = 44) between the ages of 52 and 83 participated. BMI was computed and self-reported physical activity levels were obtained. Subjects were grouped by age (5-year intervals), BMI (normal, over-weight, and obese) and sex. Each participants performance on the FMS™ was digitally recorded for later analysis. Results The youngest age group (50–54 years) scored highest in all seven tests and the oldest age group (75+) scored lowest in most of the tests compared to all other age groups. The subjects in the “normal weight” group performed no different than those who were in the “overweight” group; both groups performed better than the “obese” group. Of the 97 participants 54 had at least one asymmetry. The pairwise correlations between the total FMS™ score and age (r = −0.531), BMI (r = −0.270), and the measure of activity level (r = 0.287) were significant (p < 0.01 for all). Conclusion FMS™ scores decline with increased BMI, increased age, and decreased activity level. The screen identifies range of motion- and strength-related asymmetries. The FMS™ can be used to assess functional limitations and asymmetries. Future research should evaluate if a higher total FMS™ score is related to fewer falls or injuries in the older population.